Simultaneous liver, pancreas-duodenum and kidney transplantation in a patient with hepatitis B cirrhosis, uremia and insulin dependent diabetes mellitus

Simultaneous liver,pancreas-duodenum,and kidney transplantation has been rarely reported in the literature. Here we present a new and more efficient en bloc technique that combines classic orthotopic liver and pancreas-duodenum transplantation and heterotopic kidney transplantation for a male patient aged 44 years who had hepatitis B related cirrhosis,renal failure,and insulin dependent diabetes mellitus(IDDM). A quadruple immunosuppressive regimen including induction with basiliximab and maintenance therapy with tacrolimus,mycophenolate mofetil,and steroids was used in the early stage post-transplant. Postoperative recovery was uneventful and the patient was discharged on the 15 th postoperative day with normal liver and kidney function. The insulin treatment was completely withdrawn 3 wk after operation,and the blood glucose level remained normal. The case findings support that abdominal organ cluster and kidney transplantation is an effective method for the treatment of end-stage liver disease combined with uremia and IDDM.

Modified upper abdominal cluster transplantation in patients with end-stage liver diseases associated with insulin dependent type 2 diabetes mellitus

Objective Modified upper abdominal cluster transplantation ( MCT) ,which was inspired by classical cluster transplant technique,has been proven more effective and feasible in the treatment of patients with end stage liver diseases associated with insulin - dependent

CHANGES OF NAILFOLD MICROCIRCULATION IN PATIENTS OF TYPE II DIABETES MELLITUS WITH DIABETIC RETINOPATHY

Objective. To study the changes of microcirculation in patients with diabetic retinopathy(DR). Methods. Examination were performed in 153 cases of type Ⅱ diabetes mellitus, among them, 72 cases were male, 81 cases were female, mean age 57.0±10.0 years, mean disease course 8.2±7.5 years. All cases were examined fundi by ophthalmologist, urinary albumin excretion rate (UAE) in 24 hours was measured by radioimmunoassay. Moreover, we examined the blood glucose, blood pressure, blood viscosity and observed the changes of naifold microcirculation. Results.It was found that there were more evident disturbance of microcirculation, markedly slowed velocity of blood flow(P<0.05), significantly increased aggregation of blood cells(P<0.05) and exudation around the loop(P<0.05) in the group with DR, compared with the group without DR. Conclusion. It was more evident disturbance of nailfold microcirculation in patients with diabetic retinopathy.

Simultaneous development of diabetic ketoacidosis and Hashitoxicosis in a patient treated with pegylated interferon-alpha for chronic hepatitis C

Classical interferon-alpha has been shown to be correlated with the development of a variety of autoimmune disorders. A 38 year-old female patient developed simultaneously diabetic ketoacidosis and hyperthyroidism 5 mo following initiation of treatment with pegylated interferon-α and ribavirin for chronic hepatitis C. High titers of glutamic acid decarboxylase, antinuclear and thyroid (thyroid peroxidase and thyroglobulin) antibodies were detected. Antiviral treatment was withdrawn and the patient was treated with insulin for insulin-dependent diabetes mellitus and propranolol for hyperthyroidism. Twelve months after cessation of pegylated interferon-α therapy the patient was euthyroid without any medication but remained insulin-dependent.

CLINICAL ANALYSIS OF 52 CASES OF JUVENILE DIABETES MELLITUS

The clinical significance of 52 cases of juvenile diabetes mellitus is reported in the article.The ratio of male to female was 1:2.5. 21.2% had the episode of infection prior to the onset of the disease;6.5% had positive family history.It is suggested from the article that more attention should be paid to nontypical cases which would incur misdiagnosis and improper treatment;and it might be necessary to differentiate the ketoacidosis from just positive ketonuria reaction. As for the latter,insulin hypodermic injection probably is more feasible than intravenous effusion.

Rhabdomyolysis and Acute Pancreatitis in Diabetic Ketoacidosis: A Case Report and Review of Literature

Diabetic ketoacidosis (DKA) is a life-threatening complication in patients with Type 1 or Type II. Diabetes Mellitus resulting in fluid shifts, electrolytes imbalance and acid-base disorders, can lead to multi-organ Failure. The Pancreas and skeletal muscles are not commonly affected in DKA. We present a case of 41-year-old female who was initially admitted in intensive care unit for treatment of Diabetic ketoacidosis, and was treated appropriately later she complained of abdominal pain and generalized myalgia. Hospital course was complicated with Acute pancreatitis and Rhabdomyolysis. Serum electrolytes were significant for hypo-phosphatemia. Workup for myositis and acute pancreatitis were negative. The exact etiology is unknown, but it is proposed in many literature articles that serum hyper-osmolarity and/or electrolyte abnormalities can be the culprits in triggering the complications.

Celiac disease in Middle Eastern and North African countries:A new burden?

Celiac disease(CD) is now recognized as a common disorder among Middle Eastern(ME) and North African(NA) populations.The aim of this review is to assess the available data regarding CD in the ME and NA and to compare this information with that of Western countries.A literature review was performed using the electronic databases PubMed and Medline(1950-2008) as search engines,and "celiac disease" was used as a Mesh term.The search was limited to ME and NA countries.The prevalence of CD in ME and NA countries among low risk populations is similar to that of Western countries,but is higher in high risk populations such as those with type 1 diabetes.It is underestimated because of lack of clinical suspicion and lack of patient awareness.Clinical presentations in term of gastrointestinal,hematologic,skeletal,and liver manifestations are similar between both populations except for a high prevalence of short stature in some ME and NA countries.Few studies have addressed atypical or silent CD.As in the West,diagnosis is initially made by serological tests and is confirmed by small intestinal biopsies.Gluten-free diet is the main mode of treatment with a higher apparent adherence rate than in the West.Most disease complications result from malabsorption.The disease is strongly associated with HLA DQ2 and to a lesser extent with HLA DQ8 alleles.In conclusion,CD prevalence is underestimated,with little data available about its malignant complications.Disease parameters in the ME and NA are otherwise similar to those in Western countries.

Reactivity of Human Preformed Natural Antibodies with Various Porcine Pancreatic Cells

The reactivity of human preformed natural antibodies (PNAbs) with various porcine pancreatic cells and its isotypes was investigated. Eighteen serum samples from patients with insulin dependent diabetes mellitus (IDDM) and 20 serum samples from healthy human subjects were collected. The frozen sections of the pig pancreas were incubated with these sera, and subsequently incubated with FITC conjugated goat antihuman IgG and IgM monoclonal antibodies. The reactivity of human PNAbs with various porcine pancreatic cells was determined by indirect immunofluorescence staining technique. The results showed that 55.6 % of IDDM patients and 55.0 % of healthy human individuals contained PNAbs against porcine endocrine cells. However, the percentage of strongly reacting sera in the patient group was significantly increased as compared with that in the control group. All used sera from IDDM patients and 95 % of sera from healthy controls could react to one or more of the various pancreatic cell types, including: endocrine cells, exocrine cells, vascular endothelial cells, ductal epithelial cells and macrophages. The isotypes of PNAbs contained both IgG and IgM. In view of strongly positive reactivity of PNAbs with various porcine pancreatic cells, pretransplantly cross matching test and graft pretreatment may be necessary for survival of islet transplants.

Relationship between angiotensinogen gene M235 Tvariant with diabeticnephropathy in Chinese N I D D M

Objective To investigate whether angiotensinogen (AGT) gene M235T variant is associated with non insulin dependent diabetes mellitus without nephropathy (DN -), and diabetic nephropathy (DN +) in Chinese non insulin dependent diabetes mellitus (NIDDM) Methods The subjects in DN + group, DN - group and control group were well matched with sex, age and duration of disease, and the two case groups were divided into two subgroups as with and without hypertension respectively The M235T polymorphism of AGT gene of 84 cases with DN -, 96 patients with DN + and 98 controls were determined by polymerase chain reaction (PCR) amplification and restriction fragment length polymorphism (RFLP) analysis of the region of the variant, i e M235T polymorphism Results The increased frequencies of T allele (0 82) and TT genotype (0 70) were observed in 96 subjects with DN + as compared with 98 control subjects (0 63 and 0 43, respectively, P =0 003, P =0 0004) The odds ratio associated with TT genotype was 3 47 (95%CI: 1 51-7 94; P =0 0033) for diabetic nephropathy in analysis adjusted for several risk factors of diabetic nephropathy, such as body mass index, systolic and diastolic blood pressure, serum cholesterol, low density lipoprotein and high density lipoprotein Subgroup analysis of the 67 patients in DN + group with hypertension revealed similar distributions of M235T genotypes and alleles to those in the DN + without hypertension subgroup There was no difference in allele and genotype distribution between 84 DN - patients and the controls Similarly, frequencies of the AGT M235T genotype and allele were not different between two DN - subgroups Conclusions AGT gene M235T polymorphism is associated with diabetic nephropathy in NIDDM TT genotype of the AGT gene might be an independent risk factor of diabetic nephropathy in Chinese NIDDM patients

A review on Malaysian medicinal plants having anti-hyperglycemic activity

The use of natural products as a source of remedies has long history since ancient times.Currently,medicinal plants are traditional practices for an extensive range of therapeutics and pharmacological activities like hypoglycemic,immunological,antiviral,anti-inflammatory,anti-hepatic,cardiovascular and central nervous effect.In the past,the use of plant based medicines was mainly restricted to developing countries because of insufficient resources,but currently the trend is changed and natural products as a source of medicines are growing rapidly in developed countries.It is confirmed from research articles that nearly about 75%-80%of the reserved zone inhabitants used natural products for their health remedies.In all,about 250000-500000 species of plants exist worldwide and almost 800 plants have been documented for use in folklore systems of medicine.Regarding to this,Malaysia is being accepted as one of the largest biodiversity countries.In Malaysia,12000 species of natural products exist and 1200 are documented to have remedial potential against various diseases.In the market,a variety of allopathic drugs are available,but are linked to various side effects.Hence,there is rising interest in the direction to plant based medicines remedies with a basic tactic towards the nature.The anti-diabetic drugs from natural products source in current use and their same way of producing action are preferred mainly due to affordable price,easy availability and minor harmful effect on human beings.Therefore,the aim of the present research work was to review various Malaysian medicinal plants having potential in attenuation of high level of blood glucose.All over the world,diabetes mellitus is claimed to be one of the most common chronic hereditary non-communicable disease,fourth leading cause of mortality in the most developed countries.The disease is also spreading in many developing and newly industrialized nations.According to International Diabetes Federation,the diabetes will affect 592 million people in 2035.